Menopause Groups Aim to Quash Hormone Therapy Conflict

A week after the founder of the North American Menopause Society (NAMS) attacked the Women's Health Initiative (WHI) conclusions on hormone therapy for menopausal women, that society and 14 others banded together Monday, issuing a statement aimed at clarifying confusion that's persisted for a decade.

A decade after the WHI concluded that the risks of hormone therapy outweighed its benefits, Wulf Utian MBBCh, PhD, called for an independent review of all major WHI publications, claiming in Climacteric that the trial overstated the risks of breast cancer, coronary heart disease, stroke, and pulmonary embolism with estrogen-progestogen treatment.

The organization he founded and now serves as executive director emeritus was quick to note that Utian did not speak for the society and noted that the society recently updated it's official position on hormone therapy - that it has a role in short-term treatment of menopause symptoms but is too risky for long-term use in osteoporosis or other disease prevention.

That position statement, issued by NAMS, the American Society for Reproductive Medicine, and the Endocrine Society, and endorsed by 12 other women's health organizations, was primarily aimed at addressing the "misperception" that "even the experts don't agree," according to a press release issued Monday on the 10th anniversary of the WHI conclusion that touched off a firestorm.

"Women and clinicians have been frustrated by the many conflicting recommendations over the past 10 years. This statement should be reassuring to all," Margery Gass, MD, executive director of NAMS, said in the press release.

That effort may be somewhat complicated by fact that the International Menopause Society, which published and came out in support of Utian's views, is a notable exception to the list of organizations signing on to the updated statement.

The new position statement notes the low absolute risk of short-term treatment of menopausal symptoms in women ages 50 to 59 and those with premature or early menopause, calling those groups an appropriate population for hormone therapy at least until the median natural menopause age of 51.

"We want to emphasize the difference between taking hormone therapy short-term for treatment of menopausal symptoms versus taking hormone therapy for prevention of chronic diseases," Gass explained. "Many women can safely take hormone therapy for relief of menopausal symptoms when they work closely with their provider to assess their personal risks and benefits."

Other conclusions in the statement released in Menopause: The Journal of The North American Menopause Society include:

Individualization of hormone therapy is key, based on health and quality of life priorities as well as personal risk of venous thrombosis, heart disease, stroke, and breast cancerA limitation on duration of estrogen-progestogen therapy by the increased risk of breast cancer and breast cancer mortality associated with 3 to 5 years of useA safer profile of estrogen alone (for women who have had their uterus removed) over a mean of 7 years of use and 4 years of follow-up, allowing more flexibility in duration of useA recommendation for low-dose, vaginal estrogen therapy as the most effective treatment when only vaginal symptoms are presentA lack of data supporting safety of estrogen in breast cancer survivorsA potentially lower risk of venous thromboembolism and stroke with transdermal and low-dose oral estrogen, though without randomized controlled trial evidence